大型社区医疗系统中动脉粥样硬化性心血管疾病患者的血脂检测率

IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Journal of clinical lipidology Pub Date : 2024-07-01 DOI:10.1016/j.jacl.2024.04.013
Hsin-Fang Li PhD, Roshanthi Weerasinghe MPH, Staci Wendt PhD, Eduard Sidelnikov MD, Bethany Kalich PharmD, Niranjan Kathe PhD, Tyler Gluckman MD, Andrew Nute MPH
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引用次数: 0

摘要

研究经费本研究由加利福尼亚州千橡市的安进公司赞助。背景/简介目前美国心脏病学会/美国心脏协会(ACC/AHA)的血液胆固醇管理指南建议接受降胆固醇治疗的患者每 3 到 12 个月重复进行一次血脂检测,以监测服药依从性和治疗效果。我们对美国西部一个大型社区医疗系统在 2017 年 1 月 1 日至 2022 年 12 月 31 日期间收治的动脉粥样硬化性心血管疾病(ASCVD)患者进行了回顾性横断面分析。根据 ASCVD 风险状态(根据 ACC/AHA 指南,极高风险 [VHR] 与非极高风险 [NVHR])分层,使用 12 个月的回溯法按血脂检测率计算年度队列快照的百分比。我们还进行了其他分析,以评估这些百分比是否在 1) 24 个月回溯(2018-2022 年)和 2) 12 个月回溯加 3 个月回溯的情况下发生变化。在医疗系统外进行的血脂检测不在审查范围内。结果共确定了 855,258 名独特的>1 次就诊的 ASCVD 患者(年度患者人数从 2017 年的 184,860 人到 2022 年的 430,481 人不等)。平均年龄为 71.7 岁,44.8% 为女性,78.6% 为白人。以 12 个月为回顾期,2017 年和 2022 年分别只有 33.6% 和 37.2% 的患者进行了血脂检测。与 NVHR(2017 年为 29.2%,2022 年为 33.5%)相比,VHR(2017 年为 36.2%,2022 年为 39.8%)患者中进行过血脂检测的比例一直较高。在 24 个月的回溯中,所有组别中进行了部分血脂检测的患者比例均随时间推移而上升(2018 年,所有患者为 47.8%,VHR 患者为 50.9%,NVHR 患者为 42.0%;2022 年,所有患者为 51.5%,VHR 患者为 54.1%,NVHR 患者为 46.6%)。采用 12 个月回顾加 3 个月前瞻的方法也观察到类似的模式,但不太明显(2017 年所有患者为 42.9%,VHR 患者为 44.9%,NVHR 患者为 39.3%;2022 年所有患者为 47.5%,VHR 患者为 49.3%,NVHR 患者为 44.0%)。虽然随着时间的推移,每年的百分比趋向于血脂检测率较高的类别,并且在VHR患者中一直较高,但仍需进一步调查以确定与不同血脂检测率相关的因素。
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Rates of Lipid Testing among Patients with Atherosclerotic Cardiovascular Disease within a Large Community-Based Health System

Study Funding

This study was sponsored by Amgen, Inc., Thousand Oaks, California.

Background/Synopsis

Current American College of Cardiology/American Heart Association (ACC/AHA) guidelines for blood cholesterol management recommend that patients on cholesterol lowering therapy undergo repeat lipid testing every 3 to 12 months to monitor medication adherence and therapeutic effect. Contemporary rates of testing are not well known.

Objective/Purpose

pending

Methods

We performed a retrospective cross-sectional analysis of patients with atherosclerotic cardiovascular disease (ASCVD) cared for within a large community-based health system within the western US between January 1, 2017, and December 31, 2022. Percentages of annual cohort snapshots were calculated by lipid testing rates using a 12-month look back, stratified by ASCVD risk status (very high-risk [VHR] vs not very high-risk [NVHR] per ACC/AHA guidelines). Additional analyses were performed to assess whether these percentages varied using 1) a 24-month look back (2018-2022) and 2) a 12-month look back plus 3-month look forward. Lipid tests performed outside of the health system were not available for review.

Results

A total of 855,258 unique patients with >1 encounter for ASCVD were identified (annual patient counts ranged between 184,860 in 2017 and 430,481 in 2022). The mean age was 71.7 years, 44.8% were female, and 78.6% were White. Using a 12-month look back, only 33.6% and 37.2% of patients underwent some lipid testing in 2017 and 2022, respectively. Consistently higher percentages had some lipid testing among those that were VHR (36.2% in 2017 and 39.8% in 2022) compared to NVHR (29.2% in 2017 and 33.5% in 2022). With a 24-month look back, percentages with some lipid testing rose for all groups over time (47.8% for all patients, 50.9% for VHR patients, and 42.0% for NVHR patients in 2018; 51.5% for all patients, 54.1% for VHR patients, and 46.6% for NVHR patients in 2022). A similar, but less pronounced pattern was observed using a 12-month look back plus 3-month look forward (42.9% for all patients, 44.9% for VHR patients, and 39.3% for NVHR patients in 2017; 47.5% for all patients, 49.3% for VHR patients, and 44.0% for NVHR patients in 2022).

Conclusions

Despite guideline recommendations, a large percentage of patients did not undergo any lipid testing in our health system within 12 or 24 months prior to an encounter involving ASCVD. While annual percentages trended toward categories of higher lipid testing rates over time and were consistently higher among VHR patients, further investigation is needed to identify factors associated with different rates of lipid testing.

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来源期刊
CiteScore
7.00
自引率
6.80%
发文量
209
审稿时长
49 days
期刊介绍: Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. While preference is given to material of immediate practical concern, the science that underpins lipidology is forwarded by expert contributors so that evidence-based approaches to reducing cardiovascular and coronary heart disease can be made immediately available to our readers. Sections of the Journal will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.
期刊最新文献
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